| NPI | 1912475047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.024065) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0015886) |
| Enumeration Date | 2018-11-07 |
| Last Update Date | 2018-11-07 |