| NPI | 1427210038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501013820) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 12339) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2026-03-27 |