| NPI | 1194423335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501302550) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P22791) |
| Enumeration Date | 2023-02-17 |
| Last Update Date | 2024-08-29 |