| NPI | 1790049757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 1104905) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.017901) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2016-06-16 |