| NPI | 1386808152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501009997) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MI 109402413) |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2009-01-28 |