| NPI | 1801005335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: IL 070017777) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 10130-024) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2017-02-28 |