| NPI | 1851730725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501017655) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 60252) |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2021-04-19 |