| NPI | 1922528389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.022905) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 039599) |
| Enumeration Date | 2017-06-26 |
| Last Update Date | 2024-11-19 |