| NPI | 1245459932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT30291) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501012111) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2024-11-25 |