| NPI | 1730807355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: CA 28941) |
| Additional Taxonomies | 314000000X Skilled Nursing Facility (Licence: CA 28941) |
| Enumeration Date | 2022-08-19 |
| Last Update Date | 2022-08-19 |