| NPI | 1508892027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070-013278) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 9778-24) |
| 225100000X Physical Therapist (Licence: MI 5501012458) | |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2018-09-05 |