| NPI | 1396077590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 63-033498) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-017578) |
| Enumeration Date | 2010-02-12 |
| Last Update Date | 2014-05-28 |