| NPI | 1649428913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: FL PT9195) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT9115) |
| Enumeration Date | 2008-08-28 |
| Last Update Date | 2008-08-28 |