| NPI | 1295253763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251N0400X Physical Therapist, Neurology (Licence: MI 5501021663) |
| Additional Taxonomies | 156F00000X Technician/Technologist |
| Enumeration Date | 2017-09-05 |
| Last Update Date | 2022-07-21 |