| NPI | 1245438902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: NC 3980) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: NC 5399) |
| Enumeration Date | 2007-07-04 |
| Last Update Date | 2007-07-08 |