| NPI | 1831452689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070018120) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 07517F) |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2012-06-18 |