| NPI | 1396224879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 30527) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501018808) |
| Enumeration Date | 2018-08-07 |
| Last Update Date | 2019-02-21 |