| NPI | 1326249103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MI 5501007156) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501007156) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2011-10-07 |