| NPI | 1942702568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501017815) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT017267) |
| Enumeration Date | 2018-02-28 |
| Last Update Date | 2018-02-28 |