| NPI | 1174807465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 046157) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-018786) |
| Enumeration Date | 2011-10-05 |
| Last Update Date | 2021-01-18 |