| NPI | 1679752752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00010766) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070019792) |
| Enumeration Date | 2007-10-25 |
| Last Update Date | 2018-03-01 |