| NPI | 1073996310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT 30037) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501011685) |
| Enumeration Date | 2015-07-06 |
| Last Update Date | 2023-02-17 |