| NPI | 1962895136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P13968) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501013657) |
| Enumeration Date | 2015-03-12 |
| Last Update Date | 2015-03-12 |