| NPI | 1679171342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070-026470) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CT 13054) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: NJ 40QA01961200) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: NY 046507) | |
| Enumeration Date | 2020-10-14 |
| Last Update Date | 2022-04-27 |