| NPI | 1417359043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1370987) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501016850) |
| Enumeration Date | 2014-09-26 |
| Last Update Date | 2023-09-08 |