| NPI | 1205051901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: IL 070-007745) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-007745) |
| 2251S0007X Physical Therapist, Sports (Licence: IL 070-007745) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: IL 070-007745) | |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2024-09-30 |