| NPI | 1831355494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501016358) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 9916-024) |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2019-04-30 |