| NPI | 1356682587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MI 5501015955) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501015595) |
| 2251G0304X Physical Therapist, Geriatrics (Licence: MI 5501015955) | |
| 2251S0007X Physical Therapist, Sports (Licence: MI 5501015595) | |
| Enumeration Date | 2013-03-13 |
| Last Update Date | 2013-03-13 |