| NPI | 1952722902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2014011103) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070020454) |
| Enumeration Date | 2013-12-18 |
| Last Update Date | 2017-02-22 |