| NPI | 1487167722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1407434) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501303259) |
| 3747P1801X Technician, Personal Care Attendant | |
| Enumeration Date | 2017-11-08 |
| Last Update Date | 2025-12-02 |