| NPI | 1053443044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501009157) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05008953A) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2010-12-17 |