| NPI | 1992991848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 11339) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501011596) |
| Enumeration Date | 2007-09-24 |
| Last Update Date | 2015-10-21 |