| NPI | 1649653858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 11825PT) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070021379) |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2015-09-21 |