| NPI | 1487848610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 08138R) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 70015956) |
| Enumeration Date | 2007-08-30 |
| Last Update Date | 2012-02-24 |