| NPI | 1922472703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501017334) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1266908) |
| 225100000X Physical Therapist (Licence: OR 61398) | |
| Enumeration Date | 2015-11-17 |
| Last Update Date | 2015-11-17 |