| NPI | 1578045027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 24645) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MI 5501018825) |
| Enumeration Date | 2018-08-31 |
| Last Update Date | 2019-11-18 |