| NPI | 1699916882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P15031) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501013706) |
| Enumeration Date | 2009-03-17 |
| Last Update Date | 2014-10-09 |