| NPI | 1922370857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501018260) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 004883) |
| 225100000X Physical Therapist (Licence: OR 60259) | |
| Enumeration Date | 2012-02-08 |
| Last Update Date | 2018-03-17 |