| NPI | 1376271007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT8114) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501302187) |
| Enumeration Date | 2022-08-10 |
| Last Update Date | 2025-12-15 |