| NPI | 1982825535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501017629) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT.014053) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2016-03-25 |