| NPI | 1629116116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070019023) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 027465) |
| 225100000X Physical Therapist (Licence: NJ 40QA01244600) | |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2021-04-08 |