| NPI | 1386952489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305207297) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501013722) |
| Enumeration Date | 2010-09-23 |
| Last Update Date | 2012-06-20 |