| NPI | 1922116375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501010439) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 232410) |
| Enumeration Date | 2006-08-27 |
| Last Update Date | 2017-03-01 |