| NPI | 1437163748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 12846) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501012011) |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2013-10-08 |