| NPI | 1841952801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501020235) |
| Enumeration Date | 2021-10-07 |
| Last Update Date | 2022-02-18 |