| NPI | 1326495664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1395000) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501017540) |
| Enumeration Date | 2016-05-17 |
| Last Update Date | 2025-08-07 |