| NPI | 1518312982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501015359) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 15713) |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2019-11-01 |