| NPI | 1477722908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501014690) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 8033) |
| Enumeration Date | 2008-02-28 |
| Last Update Date | 2024-12-23 |