| NPI | 1497014237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: IL 070016146) |
| Additional Taxonomies | 2251C2600X (Licence: IL 070016146) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: IL 070016146) | |
| Enumeration Date | 2012-05-14 |
| Last Update Date | 2012-05-14 |