| NPI | 1245906213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 12823) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501020145) |
| Enumeration Date | 2021-08-19 |
| Last Update Date | 2025-07-30 |