| NPI | 1780874305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH 011677) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501013335) |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2013-11-06 |