| NPI | 1578912663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1289552) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501013298) |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2024-10-11 |