| NPI | 1447448568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501012041) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 5691362UPD) |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2007-10-15 |