| NPI | 1013184688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251G0304X Physical Therapist Geriatrics (Licence: NC 13298) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 018490-1) |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2011-08-18 |