| NPI | 1861869026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501017646) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 42941) |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2016-04-20 |