| NPI | 1386650885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.006954) |
| Additional Taxonomies | 174400000X Specialist (Licence: IN 05003251A) |
| 174400000X Specialist (Licence: IL 070006954) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2014-04-17 |