| NPI | 1720253453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05010272A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070016068) |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2018-03-17 |