| NPI | 1538124003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL 25754) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501007428) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2022-07-21 |