| NPI | 1396758603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070018357) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038-008864) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2016-08-23 |