| NPI | 1619449428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 18340) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501018694) |
| 225100000X Physical Therapist (Licence: SC .9139) | |
| Enumeration Date | 2018-12-19 |
| Last Update Date | 2018-12-19 |