| NPI | 1053062208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501005346) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT32739) |
| Enumeration Date | 2022-01-10 |
| Last Update Date | 2022-01-10 |