| NPI | 1942296637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 01358) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070006210) |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2013-01-10 |