| NPI | 1578961686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 7846) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501016636) |
| Enumeration Date | 2014-12-06 |
| Last Update Date | 2018-12-05 |