| NPI | 1508136672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1212910) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501013687) |
| Enumeration Date | 2012-01-06 |
| Last Update Date | 2019-01-18 |