| NPI | 1720046360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 02209) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-010146) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2012-04-11 |