| NPI | 1003847328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070006441) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096-000362) |
| 2251H1200X Physical Therapist, Hand (Licence: IL 971100300) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2008-11-26 |