| NPI | 1750538815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: TX 1190708) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1190708) |
| 225100000X Physical Therapist (Licence: IL 070016619) | |
| 2251X0800X Physical Therapist Orthopedic (Licence: IL 070016619) | |
| Enumeration Date | 2008-08-20 |
| Last Update Date | 2009-09-17 |