| NPI | 1306408844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501019542) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT34775) |
| Enumeration Date | 2019-07-05 |
| Last Update Date | 2020-09-10 |