| NPI | 1740779214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501018663) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: IN 05013211A) |
| Enumeration Date | 2018-05-09 |
| Last Update Date | 2024-07-10 |