| NPI | 1720703531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: WI 16896-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501302163) |
| Enumeration Date | 2022-10-05 |
| Last Update Date | 2024-12-20 |