| NPI | 1659949246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501020009) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5501020009) |
| Enumeration Date | 2021-06-11 |
| Last Update Date | 2021-09-10 |