| NPI | 1124239785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 8359) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501012789) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2010-06-02 |