| NPI | 1912196395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501012007) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MI 5501012007) |
| Enumeration Date | 2007-10-22 |
| Last Update Date | 2011-08-16 |