| NPI | 1881348878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501303449) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P20952) |
| Enumeration Date | 2022-02-08 |
| Last Update Date | 2024-09-12 |