| NPI | 1285824581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501010780) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 9719-024) |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2012-05-17 |