| NPI | 1558759704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501019192) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070021227) |
| Enumeration Date | 2014-12-22 |
| Last Update Date | 2019-06-25 |