| NPI | 1699917070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501018393) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-017012) |
| Enumeration Date | 2009-03-31 |
| Last Update Date | 2018-06-07 |