| NPI | 1104010354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070015891) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 03195-1) |
| 225100000X Physical Therapist (Licence: MA 19228) | |
| Enumeration Date | 2007-08-30 |
| Last Update Date | 2024-06-03 |