| NPI | 1184744153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: CA 34859) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: OH 10669) |
| 2251G0304X Physical Therapist, Geriatrics (Licence: PA 18540) | |
| Enumeration Date | 2007-03-31 |
| Last Update Date | 2008-12-15 |