| NPI | 1619274438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT 60520702) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070012651) |
| Enumeration Date | 2011-02-14 |
| Last Update Date | 2015-06-29 |