| NPI | 1316450356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.022066) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 075242) |
| 225100000X Physical Therapist (Licence: IN 05007445A) | |
| Enumeration Date | 2017-11-13 |
| Last Update Date | 2017-11-13 |