| NPI | 1770158750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-033860) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 304092) |
| 225100000X Physical Therapist (Licence: MI 5501019875) | |
| Enumeration Date | 2021-05-23 |
| Last Update Date | 2024-11-22 |