| NPI | 1679851661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251G0304X Physical Therapist Geriatrics (Licence: VA 2305206502) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2017-10-09 |