| NPI | 1801925730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P12948) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501015127) |
| 225100000X Physical Therapist (Licence: AZ 7604) | |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2017-07-15 |