| NPI | 1073845970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 042897) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-17607) |
| 225100000X Physical Therapist (Licence: CA 40203) | |
| Enumeration Date | 2010-02-03 |
| Last Update Date | 2019-06-14 |