| NPI | 1366229221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MI 5501303003) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2023-09-13 |
| Last Update Date | 2024-06-20 |