| NPI | 1407222698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1298080) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-21531) |
| Enumeration Date | 2015-08-11 |
| Last Update Date | 2020-07-29 |