| NPI | 1417355439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 22632) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501013111) |
| 225100000X Physical Therapist (Licence: NM 4074) | |
| Enumeration Date | 2014-12-08 |
| Last Update Date | 2014-12-08 |