| NPI | 1962945337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: SC 8097) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: NY 020395) |
| Enumeration Date | 2016-12-02 |
| Last Update Date | 2016-12-02 |