| NPI | 1619304599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070021940) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 12268-24) |
| 225100000X Physical Therapist (Licence: MN 9025) | |
| Enumeration Date | 2013-10-09 |
| Last Update Date | 2018-01-11 |