| NPI | 1821330085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070020639) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 62038) |
| 225100000X Physical Therapist (Licence: NY 031908-1) | |
| 225100000X Physical Therapist (Licence: WI 12266-24) | |
| Enumeration Date | 2013-03-25 |
| Last Update Date | 2020-03-19 |