| NPI | 1861280893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251E1300X Physical Therapist, Electrophysiology, Clinical |
| Additional Taxonomies | 174200000X Meals |
| 177F00000X Lodging | |
| 343900000X Non-emergency Medical Transport (VAN) (Licence: MI 5802020115) | |
| Enumeration Date | 2025-04-29 |
| Last Update Date | 2025-05-06 |