| NPI | 1568128544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: MO 2011017512) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: MO 2011017512) |
| Enumeration Date | 2021-11-13 |
| Last Update Date | 2021-11-13 |