| NPI | 1851787642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 037640-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070021335) |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2018-08-30 |