| NPI | 1801118831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT28912) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501011721) |
| Enumeration Date | 2010-02-18 |
| Last Update Date | 2023-10-11 |