| NPI | 1649317439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 027110) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.015491) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2013-05-31 |