NPI | 1588444574 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: MI 5501021654) |
Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MI 5501021654) |
Enumeration Date | 2023-10-05 |
Last Update Date | 2024-10-06 |