| NPI | 1548986763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251G0304X Physical Therapist Geriatrics (Licence: VT 040.0134321) |
| Additional Taxonomies | 2251G0304X Physical Therapist Geriatrics (Licence: FL PT38259) |
| Enumeration Date | 2022-10-19 |
| Last Update Date | 2022-10-19 |