| NPI | 1184966673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305207325) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501014456) |
| Enumeration Date | 2013-03-22 |
| Last Update Date | 2013-03-22 |