| NPI | 1598192312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501019771) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AK PHYP2677) |
| Enumeration Date | 2013-10-11 |
| Last Update Date | 2025-02-19 |