| NPI | 1568702686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: IL 070022764) |
| Additional Taxonomies | 2251S0007X Physical Therapist Sports (Licence: MI 5501014647) |
| 2251X0800X Physical Therapist Orthopedic (Licence: MI 5501014647) | |
| Enumeration Date | 2013-02-26 |
| Last Update Date | 2017-01-21 |