| NPI | 1851753651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT1650) |
| Additional Taxonomies | 2251G0304X Physical Therapist Geriatrics |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2016-03-22 |