| NPI | 1598932642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501001870) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901014313) |
| 1223G0001X Dentist, General Practice (Licence: TX 23120) | |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2021-05-03 |