| NPI | 1558709212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070022388) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV PT 003162) |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2016-09-27 |