| NPI | 1972935203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 29049) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT023079) |
| 225100000X Physical Therapist (Licence: MI 5501302377) | |
| Enumeration Date | 2013-08-09 |
| Last Update Date | 2025-03-03 |