| NPI | 1043684517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 045412) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070021866) |
| Enumeration Date | 2015-11-21 |
| Last Update Date | 2021-07-12 |