| NPI | 1396141677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501016557) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2014-11-13 |
| Last Update Date | 2023-04-28 |