| NPI | 1568798692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH8155) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.017260) |
| Enumeration Date | 2009-10-24 |
| Last Update Date | 2016-12-22 |