| NPI | 1922530765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT25968) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501012429) |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2017-03-31 |