| NPI | 1386093169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501017701) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: MI 5501017701) |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2018-11-30 |