| NPI | 1730683202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5501016400) |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2021-10-18 |