| NPI | 1639642960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070025068) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: OH 17831) |
| Enumeration Date | 2019-01-09 |
| Last Update Date | 2020-10-07 |