| NPI | 1619124229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2016023770) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-016647) |
| Enumeration Date | 2008-08-26 |
| Last Update Date | 2016-07-11 |