NPI | 1740412790 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501009283) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI TL009283) |
Enumeration Date | 2009-08-10 |
Last Update Date | 2016-12-01 |