| NPI | 1922550763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM 4707) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 0013422) |
| 225100000X Physical Therapist (Licence: MI 5501017461) | |
| Enumeration Date | 2016-10-27 |
| Last Update Date | 2016-10-27 |