NPI | 1699065755 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: WA 60198453) |
Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: OR 6398) |
2251G0304X Physical Therapist, Geriatrics (Licence: CA 26149) | |
Enumeration Date | 2011-04-11 |
Last Update Date | 2011-04-11 |