| NPI | 1831472729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 9516) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: AZ 9516) |
| Enumeration Date | 2011-09-27 |
| Last Update Date | 2011-10-27 |