| NPI | 1417114281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501012206) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: FL PT 29973) |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2015-10-14 |