| NPI | 1760597595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: IL 070001931) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096000131) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2010-07-16 |