| NPI | 1619237385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 004693) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070018756) |
| Enumeration Date | 2012-05-29 |
| Last Update Date | 2019-06-26 |