| NPI | 1952699225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0015699) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-018565) |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2018-08-09 |