| NPI | 1710359955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501017371) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 43883) |
| Enumeration Date | 2015-10-27 |
| Last Update Date | 2025-10-10 |