| NPI | 1194050641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501014825) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 4715) |
| Enumeration Date | 2009-10-15 |
| Last Update Date | 2024-05-29 |