| NPI | 1407824907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 03351) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-012986) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2018-10-02 |