| NPI | 1629333943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 073211) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070018023) |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2022-07-21 |