| NPI | 1578717773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.019810) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 5802) |
| 225100000X Physical Therapist (Licence: WA 60160970) | |
| Enumeration Date | 2008-11-14 |
| Last Update Date | 2023-05-23 |