| NPI | 1518368042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05011588A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070018366) |
| Enumeration Date | 2014-09-16 |
| Last Update Date | 2017-01-18 |