| NPI | 1861681744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P16777) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI L930361) |
| Enumeration Date | 2007-10-17 |
| Last Update Date | 2019-11-12 |