| NPI | 1952602716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501014767) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2010-11-10 |
| Last Update Date | 2024-02-12 |