| NPI | 1982036257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 036025) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501016409) |
| Enumeration Date | 2013-08-08 |
| Last Update Date | 2022-02-24 |