| NPI | 1295259398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501303050) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: TN 11426) | |
| Enumeration Date | 2017-07-31 |
| Last Update Date | 2023-12-06 |