| NPI | 1619752912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5051013927) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1253690) |
| Enumeration Date | 2023-08-28 |
| Last Update Date | 2023-08-28 |