| NPI | 1568886505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT015100) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501016673) |
| Enumeration Date | 2014-02-11 |
| Last Update Date | 2025-09-12 |