| NPI | 1760632152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 6790) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070013656) |
| Enumeration Date | 2008-09-23 |
| Last Update Date | 2014-11-05 |