| NPI | 1932298643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501009312) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5501009312) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2019-05-02 |