| NPI | 1205491784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501019137) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI PENDING) |
| Enumeration Date | 2019-05-09 |
| Last Update Date | 2020-10-19 |