| NPI | 1497747323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501000577) |
| Additional Taxonomies | 2251H1200X Physical Therapist, Hand (Licence: MI 5501000577) |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2014-11-11 |