| NPI | 1609208362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 0700223615) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2014001798) |
| Enumeration Date | 2013-08-05 |
| Last Update Date | 2018-05-31 |