| NPI | 1497448187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: MI 5501302468) |
| Enumeration Date | 2023-05-30 |
| Last Update Date | 2025-04-28 |