| NPI | 1326432428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501017032) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 11436) |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2017-09-15 |