| NPI | 1659683407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501013970) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: MI 5501013970) |
| Enumeration Date | 2010-07-09 |
| Last Update Date | 2023-02-27 |