| NPI | 1679768857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: IA 004174) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070015990) |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2015-07-21 |