| NPI | 1639343932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.001244) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 5082) |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2008-04-17 |