| NPI | 1629319439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 046919) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-019755) |
| Enumeration Date | 2013-03-05 |
| Last Update Date | 2026-06-29 |