| NPI | 1871573436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501011054) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 7057) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2024-05-24 |