| NPI | 1386166841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501019629) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 10807) |
| Enumeration Date | 2017-07-16 |
| Last Update Date | 2020-07-14 |