| NPI | 1861775900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: NE 2250) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: IA 3637) |
| Enumeration Date | 2011-09-26 |
| Last Update Date | 2011-09-26 |