| NPI | 1679985360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501018119) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-020724) |
| 225100000X Physical Therapist (Licence: IN 05012402A) | |
| Enumeration Date | 2014-05-29 |
| Last Update Date | 2018-08-21 |