| NPI | 1043073331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501303520) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT41293) |
| Enumeration Date | 2024-01-31 |
| Last Update Date | 2024-10-02 |