| NPI | 1336280882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: FL PT24515) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: NY 022369) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2020-06-29 |