| NPI | 1457600702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501005260) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT 0010915) |
| 225100000X Physical Therapist (Licence: IL 070-008536) | |
| Enumeration Date | 2012-09-02 |
| Last Update Date | 2012-09-02 |