| NPI | 1689169013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT017417) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501018751) |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2018-10-29 |