| NPI | 1528489671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 9545) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.020364) |
| Enumeration Date | 2013-12-16 |
| Last Update Date | 2020-10-13 |