| NPI | 1790483527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: IL 070.027210) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.027210) |
| Enumeration Date | 2023-02-21 |
| Last Update Date | 2024-07-29 |