| NPI | 1760786891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT35727) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: FL 35727) |
| Enumeration Date | 2011-01-04 |
| Last Update Date | 2025-01-24 |