| NPI | 1285012310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MI 5502003587) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2018-02-23 |