| NPI | 1992900328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 1969) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.012796) |
| Enumeration Date | 2007-06-16 |
| Last Update Date | 2007-07-08 |