| NPI | 1114474038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070022752) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 040504) |
| Enumeration Date | 2016-09-08 |
| Last Update Date | 2016-12-20 |