| NPI | 1154599041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MI 5501004133) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT004132) |
| Enumeration Date | 2008-02-14 |
| Last Update Date | 2013-03-15 |