| NPI | 1861759094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1215520) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501014966) |
| Enumeration Date | 2012-04-12 |
| Last Update Date | 2012-04-12 |