| NPI | 1659626042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: NY 62 034964) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: RI PT02305) |
| Enumeration Date | 2012-07-21 |
| Last Update Date | 2012-07-21 |