| NPI | 1174161079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 41522) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501016520) |
| Enumeration Date | 2019-12-11 |
| Last Update Date | 2026-08-01 |