| NPI | 1083138473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MI 5501018297) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 007201) |
| Enumeration Date | 2017-07-27 |
| Last Update Date | 2022-10-25 |