| NPI | 1922342542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: NH 2926) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: MA 10529) |
| Enumeration Date | 2012-11-20 |
| Last Update Date | 2012-11-20 |