| NPI | 1124357413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1362107) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501014081) |
| Enumeration Date | 2009-12-15 |
| Last Update Date | 2024-07-16 |