| NPI | 1144799982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501004659) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 2685631) |
| Enumeration Date | 2018-11-23 |
| Last Update Date | 2018-11-23 |