| NPI | 1194127969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P13678) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501012444) |
| Enumeration Date | 2014-09-23 |
| Last Update Date | 2021-09-23 |