| NPI | 1518213404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501011255) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2012-07-28 |
| Last Update Date | 2021-11-10 |