| NPI | 1447739271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501020066) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 11974) |
| Enumeration Date | 2018-08-13 |
| Last Update Date | 2026-05-19 |