| NPI | 1184052987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1256225) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: MI 5501014107) |
| Enumeration Date | 2013-10-15 |
| Last Update Date | 2023-04-21 |