| NPI | 1891217683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: IL 070.022317) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT292035) |
| Enumeration Date | 2017-07-13 |
| Last Update Date | 2018-03-17 |