| NPI | 1679921613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501016198) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 21504) |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2016-06-01 |