| NPI | 1316128119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070019952) |
| Additional Taxonomies | 171W00000X Contractor (Licence: NY 029458-1) |
| Enumeration Date | 2007-11-20 |
| Last Update Date | 2021-11-30 |