| NPI | 1437559887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 10277) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501016941) |
| Enumeration Date | 2014-09-03 |
| Last Update Date | 2015-01-05 |