| NPI | 1093589624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 40974) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501303471) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2023-11-14 |
| Last Update Date | 2025-01-06 |