| NPI | 1912164005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2014043817) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501013442) |
| Enumeration Date | 2008-05-18 |
| Last Update Date | 2023-05-09 |