| NPI | 1154999506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC A7366) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: NC A7366) |
| Enumeration Date | 2021-06-13 |
| Last Update Date | 2021-06-15 |