| NPI | 1750581161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: KY 001077) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: IN 05002628A) |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2007-07-23 |