| NPI | 1386076024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.026428) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05011165A) |
| Enumeration Date | 2013-08-05 |
| Last Update Date | 2022-02-04 |