| NPI | 1013790278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501302398) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 16523) |
| Enumeration Date | 2023-08-14 |
| Last Update Date | 2023-08-14 |