| NPI | 1780075036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501002351) |
| Additional Taxonomies | 2251H1200X Physical Therapist, Hand (Licence: MI 9511000285) |
| Enumeration Date | 2015-02-09 |
| Last Update Date | 2015-02-09 |