| NPI | 1922051945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 21464) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: FL PT21464) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2016-06-14 |