| NPI | 1407047046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501012362) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2020-06-22 |