| NPI | 1881838704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.016749) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 3660) |
| Enumeration Date | 2009-04-22 |
| Last Update Date | 2014-08-06 |