| NPI | 1679603575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501011285) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5501011285) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2025-05-07 |