| NPI | 1700226834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070018328) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MT 5514) |
| 225100000X Physical Therapist (Licence: WI 12269-24) | |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2017-07-11 |