| NPI | 1043610199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070027646) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT.014702) |
| 225100000X Physical Therapist (Licence: WI 13706) | |
| Enumeration Date | 2014-08-26 |
| Last Update Date | 2024-02-20 |