| NPI | 1932488442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070-019137) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 11359) |
| Enumeration Date | 2011-08-15 |
| Last Update Date | 2012-08-28 |