| NPI | 1467628305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501007020) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 33924) |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2008-04-30 |