| NPI | 1225159742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1338749) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501007654) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2022-03-08 |