| NPI | 1003554759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.024114) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 040925-01) |
| Enumeration Date | 2022-05-23 |
| Last Update Date | 2022-05-23 |