| NPI | 1386860047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 11050) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501012925) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2012-01-11 |