| NPI | 1952656753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.018213) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT 26061) |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2012-07-17 |