| NPI | 1700090644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 70011348) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05006619A) |
| 225100000X Physical Therapist (Licence: MI 5501009286) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2013-12-09 |