| NPI | 1831697291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 13798) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070025786) |
| 225100000X Physical Therapist (Licence: MI 5501018520) | |
| Enumeration Date | 2018-01-30 |
| Last Update Date | 2021-11-01 |