| NPI | 1265411565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501012424) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 6946) |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2008-04-22 |