| NPI | 1235639469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501004890) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: MI 5501004890) |
| Enumeration Date | 2018-02-14 |
| Last Update Date | 2023-09-05 |