| NPI | 1356671507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 030819) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.017489) |
| Enumeration Date | 2010-01-12 |
| Last Update Date | 2010-01-12 |