| NPI | 1740575893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH 015213) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501014130) |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2015-06-29 |