| NPI | 1720456833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1258629) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.021799) |
| Enumeration Date | 2015-09-04 |
| Last Update Date | 2015-09-04 |