| NPI | 1811530058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT029978) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501019318) |
| Enumeration Date | 2019-10-21 |
| Last Update Date | 2023-11-06 |