| NPI | 1750041745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501021566) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 048143) |
| Enumeration Date | 2021-12-18 |
| Last Update Date | 2023-05-15 |