| NPI | 1528142585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05000857A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.010366) |
| 225100000X Physical Therapist (Licence: IA 00613) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2007-07-08 |