| NPI | 1417586553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT29299) |
| Additional Taxonomies | 2251G0304X Physical Therapist Geriatrics (Licence: FL PT29299) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2020-04-01 |