| NPI | 1497993174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2009004293) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2009002205) |
| 225100000X Physical Therapist (Licence: IL 070017005) | |
| Enumeration Date | 2009-02-03 |
| Last Update Date | 2009-04-21 |