| NPI | 1750528600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070014492) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 03314) |
| Enumeration Date | 2009-01-14 |
| Last Update Date | 2009-01-14 |