| NPI | 1467422931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501302534) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT012839L) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2023-10-13 |