| NPI | 1639473374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070018272) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 11677-24) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2011-01-10 |
| Last Update Date | 2018-02-27 |