| NPI | 1104943471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH6939) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501013042) |
| 225100000X Physical Therapist (Licence: NY 0285531) | |
| 225100000X Physical Therapist (Licence: PA 018437) | |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2013-10-02 |