| NPI | 1225642358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501304032) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 101487) |
| Enumeration Date | 2020-09-05 |
| Last Update Date | 2025-07-30 |