| NPI | 1073972832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501017496) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 039913) |
| Enumeration Date | 2016-02-22 |
| Last Update Date | 2024-06-26 |