| NPI | 1669666582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0012141) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070015953) |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2018-07-25 |