| NPI | 1891991162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.021819) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 014435-1) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2016-01-20 |