| NPI | 1013458769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501018125) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1264728) |
| Enumeration Date | 2017-03-14 |
| Last Update Date | 2019-06-26 |