| NPI | 1417932096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 11665) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: IL 070-012054) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2021-12-08 |