| NPI | 1073083481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT015839) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501016048) |
| Enumeration Date | 2018-11-28 |
| Last Update Date | 2023-05-17 |