| NPI | 1235433194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI L1881040) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MI L1864543) |
| Enumeration Date | 2011-01-06 |
| Last Update Date | 2011-01-06 |