| NPI | 1750820726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60742558) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070022844) |
| Enumeration Date | 2017-02-23 |
| Last Update Date | 2017-05-01 |