| NPI | 1134321367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1188720) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501013310) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2021-01-15 |