| NPI | 1093193062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501016986) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501015456) |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2021-09-14 |