| NPI | 1205234101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: CT 009093) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT37895) |
| Enumeration Date | 2014-12-09 |
| Last Update Date | 2022-06-07 |