| NPI | 1447540414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501015505) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports |
| 2251S0007X Physical Therapist, Sports (Licence: MI 5501015505) | |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2024-09-16 |