| NPI | 1427127794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501001447) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT 26265) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2015-03-23 |