| NPI | 1366600074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT37277) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501013571) |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2011-01-25 |