| NPI | 1003315110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 11321) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-03913) |
| 225100000X Physical Therapist (Licence: MI 5501013178) | |
| Enumeration Date | 2018-02-03 |
| Last Update Date | 2018-02-03 |