| NPI | 1578009544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT44217) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501018056) |
| Enumeration Date | 2017-01-13 |
| Last Update Date | 2026-01-05 |