| NPI | 1275148819 |
|---|---|
| Former Name | MARY JO WESTENDORF |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 70025611) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2020-09-10 |
| Last Update Date | 2022-07-04 |