| NPI | 1538309083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070019138) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 023521) |
| Enumeration Date | 2009-02-24 |
| Last Update Date | 2012-12-09 |