| NPI | 1356742555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT.007222) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501009987) |
| Enumeration Date | 2014-09-08 |
| Last Update Date | 2025-02-06 |