| NPI | 1811355944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070021834) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 033030) |
| Enumeration Date | 2016-02-03 |
| Last Update Date | 2022-02-11 |