| NPI | 1962864579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501015051) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2016-03-23 |