| NPI | 1427436419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1253000) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501017090) |
| 225100000X Physical Therapist (Licence: IL 070021098) | |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2018-10-31 |