| NPI | 1114136579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: CA 34315) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1170488) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2020-11-23 |