| NPI | 1205202082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MI 5501004811) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501004811) |
| Enumeration Date | 2015-08-17 |
| Last Update Date | 2017-01-11 |