| NPI | 1649924036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT7787) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501301917) |
| 225100000X Physical Therapist (Licence: AL PTH10869) | |
| Enumeration Date | 2022-02-05 |
| Last Update Date | 2024-08-15 |