| NPI | 1265703425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 25836) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 0500977A) |
| 225100000X Physical Therapist (Licence: MI 5501013526) | |
| Enumeration Date | 2012-01-19 |
| Last Update Date | 2012-01-19 |