| NPI | 1629256771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 236798) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MI 236798) |
| 235Z00000X Speech-Language Pathologist, (Licence: MI 236798) | |
| Enumeration Date | 2008-01-31 |
| Last Update Date | 2008-01-31 |