| NPI | 1801914031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: FL 24312) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 02207) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2020-02-06 |