| NPI | 1477886687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 8676) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070017406) |
| Enumeration Date | 2009-09-08 |
| Last Update Date | 2019-10-28 |