| NPI | 1720717101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501303658) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 12852760-2401) |
| Enumeration Date | 2022-06-09 |
| Last Update Date | 2025-03-10 |