| NPI | 1295125177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 25817) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501016648) |
| 225100000X Physical Therapist (Licence: NM 4579) | |
| 2251G0304X Physical Therapist, Geriatrics (Licence: MD 25817) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: MD 25817) | |
| Enumeration Date | 2015-01-29 |
| Last Update Date | 2022-02-24 |