| NPI | 1154594836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501011966) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MI L1156239) |
| Enumeration Date | 2008-04-02 |
| Last Update Date | 2025-04-18 |