| NPI | 1669609624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: NE 2821) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1188772) |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2019-09-05 |