| NPI | 1578769394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 70015561) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1165728) |
| 225100000X Physical Therapist (Licence: NC 11438) | |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2008-01-23 |