| NPI | 1760406391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH7291) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.016379) |
| 225100000X Physical Therapist (Licence: MO 2006022078) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2022-11-17 |