| NPI | 1962547976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501304374) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT-009956) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2026-03-05 |