| NPI | 1639442676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1266830) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI B152847622012) |
| Enumeration Date | 2012-02-22 |
| Last Update Date | 2020-10-15 |