| NPI | 1043413263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: MI 5501010307) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: CO 8288) |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2007-07-08 |