| NPI | 1942481288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 10634) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501013498) |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2022-12-07 |