| NPI | 1548663974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 7703) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501016963) |
| Enumeration Date | 2014-09-30 |
| Last Update Date | 2016-07-07 |