| NPI | 1669672226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305203837) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501004325) |
| 225100000X Physical Therapist (Licence: WI 5096-024) | |
| 376G00000X Nursing Home Administrator (Licence: MI 4801004349) | |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2007-07-23 |