| NPI | 1184861676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501014270) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI 5501014270) |
| Enumeration Date | 2009-01-21 |
| Last Update Date | 2016-05-06 |