| NPI | 1598361644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: IL 070025606) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070025606) |
| 225100000X Physical Therapist (Licence: TN 11800) | |
| 2251S0007X Physical Therapist, Sports (Licence: TN 11800) | |
| 2251S0007X Physical Therapist, Sports (Licence: IL 070025606) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: TN 11800) | |
| Enumeration Date | 2020-12-04 |
| Last Update Date | 2022-02-07 |