| NPI | 1285588343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 66010) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501303639) |
| Enumeration Date | 2026-02-25 |
| Last Update Date | 2026-02-25 |