| NPI | 1285282996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501019217) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2019-08-27 |
| Last Update Date | 2024-09-12 |