| NPI | 1982191946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: NV 1428) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 1428) |
| Enumeration Date | 2018-04-16 |
| Last Update Date | 2021-11-24 |