| NPI | 1457386716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501003258) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 4326 024) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2020-12-09 |