| NPI | 1982765269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MI 5501005868) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: MI 5501005868) |
| 2251N0400X Physical Therapist, Neurology (Licence: MI 5501005868) | |
| 2251S0007X Physical Therapist, Sports (Licence: MI 5501005868) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2013-12-03 |