| NPI | 1861915613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 089351) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-023097) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2020-05-14 |