| NPI | 1407891344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: MI 5501007799) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MI 5501007799) |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2007-07-08 |