| NPI | 1487161089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH11004) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501018512) |
| Enumeration Date | 2018-01-04 |
| Last Update Date | 2024-05-09 |