| NPI | 1588957922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.020293) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT013499) |
| 225100000X Physical Therapist (Licence: FL PT24581) | |
| Enumeration Date | 2011-05-18 |
| Last Update Date | 2019-05-07 |