| NPI | 1861835514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT294056) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.019751) |
| Enumeration Date | 2013-04-12 |
| Last Update Date | 2018-03-30 |