| NPI | 1518468263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0016673) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501016553) |
| Enumeration Date | 2018-02-27 |
| Last Update Date | 2022-08-09 |