| NPI | 1770837494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501007441) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT008541L) |
| Enumeration Date | 2012-11-02 |
| Last Update Date | 2018-12-20 |