| NPI | 1326467416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 36814) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501016677) |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2023-06-12 |