| NPI | 1437655230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501014463) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: 5501014463) |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2018-04-02 |