| NPI | 1629049739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1159200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501011867) |
| 225100000X Physical Therapist (Licence: CA 14873) | |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2007-07-08 |