| NPI | 1275846016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT 25486) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501014086) |
| Enumeration Date | 2010-07-21 |
| Last Update Date | 2010-07-21 |