| NPI | 1164852364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1282649) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501014616) |
| Enumeration Date | 2013-11-25 |
| Last Update Date | 2017-03-02 |