| NPI | 1013338854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 17617) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501016817) |
| Enumeration Date | 2013-12-20 |
| Last Update Date | 2022-05-04 |