| NPI | 1932483930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.019937) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 032679) |
| Enumeration Date | 2011-10-10 |
| Last Update Date | 2020-12-25 |