| NPI | 1114175098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501001186) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MI 5201003272) |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2008-09-03 |