| NPI | 1225678634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 38196) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501019451) |
| Enumeration Date | 2020-01-14 |
| Last Update Date | 2024-01-29 |