| NPI | 1083106207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501019420) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 041653-1) |
| Enumeration Date | 2018-06-04 |
| Last Update Date | 2023-01-18 |