| NPI | 1427009281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT42609) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501003177) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2025-01-30 |