| NPI | 1558779876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070020735) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0003168) |
| Enumeration Date | 2014-07-30 |
| Last Update Date | 2014-07-30 |