| NPI | 1902037617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.019863) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT009704) |
| Enumeration Date | 2009-07-29 |
| Last Update Date | 2016-03-16 |