| NPI | 1023411972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501015585) |
| Enumeration Date | 2014-10-07 |
| Last Update Date | 2025-03-04 |