| NPI | 1720129547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501017613) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070014322) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2018-06-18 |