| NPI | 1518199256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070-017211) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: OH 011445) |
| Enumeration Date | 2009-08-13 |
| Last Update Date | 2009-11-17 |