| NPI | 1922577584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT32864) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501013011) |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2023-06-27 |