| 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 |