| NPI | 1619266509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1254686) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070017076) |
| Enumeration Date | 2011-03-31 |
| Last Update Date | 2018-10-22 |