| NPI | 1174727903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501010604) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2024-10-15 |