| NPI | 1952857047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT34536) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070022609) |
| Enumeration Date | 2016-08-29 |
| Last Update Date | 2019-08-15 |