| NPI | 1154084275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 047971) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501303054) |
| Enumeration Date | 2021-10-15 |
| Last Update Date | 2024-12-02 |