| NPI | 1447500699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070018920) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05010197A) |
| 225100000X Physical Therapist (Licence: NY 031981) | |
| 225100000X Physical Therapist (Licence: VA 2305206767) | |
| 225100000X Physical Therapist (Licence: MI 5501014724) | |
| Enumeration Date | 2012-09-14 |
| Last Update Date | 2012-09-14 |