| NPI | 1952736720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501016017) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60326237) |
| 225100000X Physical Therapist (Licence: ME PT4044) | |
| 225100000X Physical Therapist (Licence: WI 12192-24) | |
| Enumeration Date | 2013-09-11 |
| Last Update Date | 2021-07-07 |