| NPI | 1114265261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 10458) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501015276) |
| Enumeration Date | 2013-01-24 |
| Last Update Date | 2025-08-14 |