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 | 2022-08-22 |