| NPI | 1104294859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 55013038968) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH7678) |
| 225100000X Physical Therapist (Licence: FL PT32572) | |
| Enumeration Date | 2015-09-11 |
| Last Update Date | 2025-06-06 |