| NPI | 1053450734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251G0304X Physical Therapist Geriatrics (Licence: MD 19852) |
| Additional Taxonomies | 2251G0304X Physical Therapist Geriatrics (Licence: VA 2305203397) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2007-07-08 |