| NPI | 1003958265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: MD 20741) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 23720) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2016-04-05 |