| NPI | 1710948757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501016106) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 7515) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2023-01-04 |