| NPI | 1336576461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 9608) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070020356) |
| Enumeration Date | 2013-10-03 |
| Last Update Date | 2021-12-26 |