| NPI | 1740744606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501302701) |
| Additional Taxonomies | 156F00000X Technician/Technologist |
| Enumeration Date | 2019-01-24 |
| Last Update Date | 2023-05-31 |