| NPI | 1740545300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: IL 070020461) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 12082-24) |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2014-02-11 |