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 |