| NPI | 1952364978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070-013772) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096-001848) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2022-07-21 |