| NPI | 1518411271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 040674) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501304146) |
| Enumeration Date | 2016-08-11 |
| Last Update Date | 2025-12-10 |