| NPI | 1790780385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: NM PT1592) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: NM 1592) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2022-03-10 |