| NPI | 1922668326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.027309) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 040268) |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2024-10-24 |