| NPI | 1376653451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2001012048) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.018364) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2020-07-07 |