| NPI | 1639400526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.003982) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05007035A) |
| Enumeration Date | 2010-01-17 |
| Last Update Date | 2012-11-28 |