| NPI | 1821109737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 07015509) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 106966) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-09-04 |