| NPI | 1982015327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT29901) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501015068) |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2018-03-28 |