| NPI | 1518434018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501017997) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 041610) |
| 225100000X Physical Therapist (Licence: IL 070022887) | |
| Enumeration Date | 2018-11-01 |
| Last Update Date | 2018-11-01 |