| NPI | 1821067398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501010071) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2003003307) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2021-04-06 |