| NPI | 1922310424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501015547) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 031257) |
| Enumeration Date | 2010-07-13 |
| Last Update Date | 2013-07-16 |