| NPI | 1013207711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501015521) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1211370) |
| Enumeration Date | 2011-04-14 |
| Last Update Date | 2021-01-07 |