| NPI | 1316902893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 550100766) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 7961) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2007-07-08 |