| NPI | 1033610886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MI 5501009637) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: MI 5501009637) |
| Enumeration Date | 2018-02-27 |
| Last Update Date | 2021-04-06 |