| NPI | 1568803377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 10903735-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070020719) |
| 225100000X Physical Therapist (Licence: DC 871476) | |
| Enumeration Date | 2013-07-09 |
| Last Update Date | 2018-09-04 |