| NPI | 1053647594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501014273) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05009974A) |
| Enumeration Date | 2009-10-18 |
| Last Update Date | 2009-10-18 |