| NPI | 1427322718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501010413) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: MI 5501010413) |
| Enumeration Date | 2012-03-04 |
| Last Update Date | 2015-03-15 |