| NPI | 1457510190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070-003772) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 5657) |
| 225100000X Physical Therapist (Licence: NC 11489) | |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2013-10-02 |