| NPI | 1285752154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT013526L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 012330) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2013-01-25 |