| NPI | 1780090514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070022248) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2014019886) |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2016-07-25 |