| NPI | 1578994398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1270593) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT022602) |
| 225100000X Physical Therapist (Licence: MI 5501014513) | |
| Enumeration Date | 2013-12-04 |
| Last Update Date | 2024-12-28 |