| NPI | 1932757622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501020172) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 4560) |
| Enumeration Date | 2019-08-27 |
| Last Update Date | 2021-08-20 |