| NPI | 1407973258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501011814) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT27795) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2014-06-20 |