| NPI | 1639125966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-32837) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501005637) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2024-01-23 |