| NPI | 1730206889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT29400) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501001775) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2014-10-06 |