| NPI | 1659475960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT33131) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501009015) |
| Enumeration Date | 2006-09-08 |
| Last Update Date | 2018-05-02 |