| NPI | 1275803488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT4438) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501015774) |
| Enumeration Date | 2012-01-04 |
| Last Update Date | 2018-03-17 |