| NPI | 1104604305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT020177) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501302987) |
| Enumeration Date | 2023-09-19 |
| Last Update Date | 2026-08-06 |