| NPI | 1548706690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070021859) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 10356) |
| 225100000X Physical Therapist (Licence: NY 034310) | |
| 225100000X Physical Therapist (Licence: NM 4575) | |
| Enumeration Date | 2017-01-12 |
| Last Update Date | 2017-01-12 |