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 |