| NPI | 1295066454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 253Z00000X In Home Supportive Care (Licence: GA 010993) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 032095) |
| 225100000X Physical Therapist (Licence: GA 010551) | |
| Enumeration Date | 2010-01-27 |
| Last Update Date | 2021-01-20 |