| NPI | 1417253451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 11920) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-018280) |
| Enumeration Date | 2011-02-09 |
| Last Update Date | 2020-09-15 |