| NPI | 1710107545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070012935) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00009340) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2013-04-04 |