| NPI | 1912937350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501008025) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT.008125) |
| 225100000X Physical Therapist (Licence: IN 05008558A) | |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2016-12-09 |