| NPI | 1659092112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501302245) |
| Additional Taxonomies | 2251E1200X Physical Therapist, Ergonomics |
| 2251G0304X Physical Therapist, Geriatrics | |
| 2251N0400X Physical Therapist, Neurology | |
| 2251P0200X Physical Therapist, Pediatrics | |
| 2251S0007X Physical Therapist, Sports | |
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2022-09-02 |
| Last Update Date | 2022-09-02 |