| NPI | 1962771857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 10973) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 004933) |
| 225100000X Physical Therapist (Licence: IL 070018983) | |
| Enumeration Date | 2011-12-21 |
| Last Update Date | 2014-11-21 |