| NPI | 1245336627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MI 5501011987) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2020-10-26 |