| NPI | 1871977348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501012433) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2015-07-15 |
| Last Update Date | 2018-03-09 |