| NPI | 1285769992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501016707) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 023970) |
| 225100000X Physical Therapist (Licence: WI 11116-24) | |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2014-12-04 |