| NPI | 1629477302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501016047) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT.013356) |
| 225100000X Physical Therapist (Licence: AZ 10829PT) | |
| Enumeration Date | 2014-08-19 |
| Last Update Date | 2019-06-19 |