| NPI | 1679624241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 9196) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501008661) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2017-03-13 |