| NPI | 1215992136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.017753) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.011704) |
| 225100000X Physical Therapist (Licence: GA PT015108) | |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2021-03-10 |