| NPI | 1710993597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: CT 005941) |
| Additional Taxonomies | 376G00000X Nursing Home Administrator (Licence: CT 001618) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2007-07-08 |