| NPI | 1518213800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070-020618) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 12003-24) |
| Enumeration Date | 2012-07-24 |
| Last Update Date | 2018-08-22 |