| NPI | 1871808402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501016218) |
| Additional Taxonomies | 225800000X Recreation Therapist (Licence: WA PT60182844) |
| Enumeration Date | 2010-08-06 |
| Last Update Date | 2021-11-24 |