| NPI | 1063766491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501015360) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MI 5501015360) |
| Enumeration Date | 2012-11-07 |
| Last Update Date | 2018-07-06 |