| NPI | 1265350458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501303919) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1407719) |
| Enumeration Date | 2026-07-07 |
| Last Update Date | 2026-07-07 |