| NPI | 1265790448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: DC PT871433) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 034222) |
| Enumeration Date | 2012-04-25 |
| Last Update Date | 2021-03-05 |