| NPI | 1922350578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT.012592) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501012102) |
| Enumeration Date | 2012-10-05 |
| Last Update Date | 2012-10-05 |