| NPI | 1952699910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05011555A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-018514) |
| Enumeration Date | 2011-07-12 |
| Last Update Date | 2017-03-21 |