| NPI | 1720094634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2005005711) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MO 2005005711) |
| 225100000X Physical Therapist (Licence: IL 070016895) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: IL 070016895) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2014-03-25 |