| NPI | 1811060742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 11065-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501014499) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: WI 11065) | |
| 225100000X Physical Therapist (Licence: GA PT008161) | |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2024-02-16 |