| NPI | 1700135274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: IL 070-019476) |
| Additional Taxonomies | 174400000X Specialist (Licence: IL 070019476) |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2018-03-17 |