| NPI | 1154853935 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.021399) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 037524) |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2017-03-30 |