| NPI | 1205231487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: TN 9009) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: FL 28026) |
| Enumeration Date | 2014-10-29 |
| Last Update Date | 2022-08-25 |