| NPI | 1235441536 |
|---|---|
| Other Name | N/A N/A N/A |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501013712) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT26588) |
| Enumeration Date | 2010-07-02 |
| Last Update Date | 2021-10-25 |