| NPI | 1528204930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: AZ 6104) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 6104) |
| Enumeration Date | 2009-01-06 |
| Last Update Date | 2009-01-06 |