| NPI | 1336299437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT041270) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501008768) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2018-04-18 |