| NPI | 1891194643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070020383) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1238910) |
| Enumeration Date | 2014-08-18 |
| Last Update Date | 2014-08-18 |