| NPI | 1962621854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: IL 070.015503) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: MO 2006022059) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2007-07-08 |