| NPI | 1861646184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT26708) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070014866) |
| 225100000X Physical Therapist (Licence: NV 2231) | |
| Enumeration Date | 2008-11-13 |
| Last Update Date | 2022-07-10 |