| NPI | 1174614317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.015656) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 025771) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2007-09-06 |