| NPI | 1992178644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 7400) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: SC 7400) |
| Enumeration Date | 2015-11-03 |
| Last Update Date | 2025-09-05 |