| NPI | 1073094157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501018865) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2018-08-27 |
| Last Update Date | 2025-12-10 |