| NPI | 1225551302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501017009) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT014306) |
| Enumeration Date | 2017-07-20 |
| Last Update Date | 2022-07-21 |