| NPI | 1417025784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 111NI0900X Chiropractor, Internist (Licence: IL 038-008716) |
| Enumeration Date | 2006-12-02 |
| Last Update Date | 2017-11-29 |