| NPI | 1912974098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070016416) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH 11471) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2009-07-02 |