| NPI | 1982614608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5101021340) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 7865) |
| 225100000X Physical Therapist (Licence: VA 2305202481) | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2014-06-19 |