| NPI | 1659899433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501018390) |
| Enumeration Date | 2017-08-31 |
| Last Update Date | 2017-08-31 |