| NPI | 1144578964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501016632) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 9941) |
| Enumeration Date | 2012-08-28 |
| Last Update Date | 2014-04-09 |