| NPI | 1851527444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 7111) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501013075) |
| Enumeration Date | 2009-06-09 |
| Last Update Date | 2009-06-09 |