| NPI | 1508162660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501015482) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MI 5501015482) |
| 2251S0007X Physical Therapist, Sports (Licence: MI 5501015482) | |
| Enumeration Date | 2011-02-07 |
| Last Update Date | 2023-01-03 |