| NPI | 1639177090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 7351) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501005423) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2009-08-05 |