| NPI | 1598111429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501303928) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070022442) |
| 225100000X Physical Therapist (Licence: MO 2020029971) | |
| 225100000X Physical Therapist (Licence: MD 26561) | |
| Enumeration Date | 2016-05-10 |
| Last Update Date | 2025-07-31 |