| NPI | 1447621842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070021862) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 0416291) |
| Enumeration Date | 2015-10-12 |
| Last Update Date | 2018-05-01 |