| NPI | 1750810818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225XP0019X Occupational Therapist, Physical Rehabilitation (Licence: MI 5201009076) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5201009076) |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2025-10-03 |