| NPI | 1184272023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI PENDING) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT018318) |
| Enumeration Date | 2019-09-03 |
| Last Update Date | 2019-09-03 |