| NPI | 1306937404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501002422) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 2653-024) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2007-07-08 |