| NPI | 1245480649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501013400) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05009370) |
| Enumeration Date | 2008-09-23 |
| Last Update Date | 2008-09-23 |