NPI | 1609083625 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501016064) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 21651) |
Enumeration Date | 2007-05-17 |
Last Update Date | 2013-02-12 |