| NPI | 1104031566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501005199) |
| Additional Taxonomies | 282NC0060X General Acute Care Hospital, Critical Access (Licence: MI 5501005199) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2007-07-08 |