| NPI | 1376993774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.024892) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MN 10290) |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2020-01-20 |