| NPI | 1013385806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501017367) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 63210) |
| 225100000X Physical Therapist (Licence: IL 070022218) | |
| Enumeration Date | 2015-09-10 |
| Last Update Date | 2021-05-25 |