| NPI | 1770893364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501014523) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2010-10-15 |
| Last Update Date | 2021-11-23 |