| NPI | 1477362994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501304144) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT42643) |
| Enumeration Date | 2024-12-31 |
| Last Update Date | 2025-11-18 |