| NPI | 1689055147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: NC 5537) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 5537) |
| Enumeration Date | 2015-06-10 |
| Last Update Date | 2015-06-10 |