| NPI | 1326119660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070016815) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: WI 11189-24) |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2009-12-07 |