| NPI | 1811911746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT012118) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501012593) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2015-12-11 |