| NPI | 1982762878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070007766) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: IL 070007766) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: IL 070007766) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2015-10-29 |