| NPI | 1326472192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070023502) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 12479-24) |
| 225100000X Physical Therapist (Licence: IA 005279) | |
| Enumeration Date | 2013-08-28 |
| Last Update Date | 2022-11-09 |