| NPI | 1992812879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2014016140) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.013844) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2014-05-30 |