| NPI | 1730450289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 23923) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501015212) |
| Enumeration Date | 2012-01-14 |
| Last Update Date | 2023-06-20 |