| NPI | 1003050162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 014886-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501007336) |
| Enumeration Date | 2009-04-20 |
| Last Update Date | 2009-04-20 |