| NPI | 1346678927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1225110) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501013155) |
| 225100000X Physical Therapist (Licence: CO PTL.0011139) | |
| Enumeration Date | 2013-10-17 |
| Last Update Date | 2014-03-28 |