| NPI | 1285848200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: WI 10662-024) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 10662-024) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2025-09-11 |