| NPI | 1730237272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501013593) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MT 1874PT) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2020-07-17 |