| NPI | 1639155807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070007653) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 017552) |
| 2251N0400X Physical Therapist, Neurology (Licence: IL 4951) | |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2020-03-05 |