| NPI | 1093947160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501013542) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT870984) |
| 225100000X Physical Therapist (Licence: CA 35900) | |
| Enumeration Date | 2009-08-21 |
| Last Update Date | 2009-08-21 |