| NPI | 1073790754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070019818) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 028647-1) |
| Enumeration Date | 2008-01-25 |
| Last Update Date | 2021-04-20 |