| NPI | 1467119024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT38083) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501304502) |
| Enumeration Date | 2021-11-18 |
| Last Update Date | 2026-05-08 |