| NPI | 1558770685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: IL 070026914) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: IL 227.016384) |
| Enumeration Date | 2014-08-02 |
| Last Update Date | 2022-10-06 |