| NPI | 1679562284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070-011452) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2000157969) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2007-07-08 |