| NPI | 1639369796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501009959) |
| Additional Taxonomies | 2251G0304X Physical Therapist Geriatrics (Licence: MI 5501009959) |
| 2251X0800X Physical Therapist Orthopedic (Licence: MI 5501009959) | |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2007-08-14 |