| NPI | 1730625971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT32266) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501018072) |
| Enumeration Date | 2017-01-11 |
| Last Update Date | 2021-07-20 |