| NPI | 1306436639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 012572) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: CT 012572) |
| Enumeration Date | 2021-01-20 |
| Last Update Date | 2022-02-13 |