| NPI | 1356645592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501016953) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 12841) |
| 225100000X Physical Therapist (Licence: IL 070.019710) | |
| Enumeration Date | 2011-01-03 |
| Last Update Date | 2022-07-14 |