| NPI | 1558753541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501014654) |
| Enumeration Date | 2015-02-27 |
| Last Update Date | 2024-02-13 |