| NPI | 1932331493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501014834) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT013208) |
| Enumeration Date | 2009-08-18 |
| Last Update Date | 2018-06-18 |