| NPI | 1154786382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501017762) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 100466) |
| Enumeration Date | 2015-12-14 |
| Last Update Date | 2018-03-29 |