| NPI | 1003008525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 1585) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 7998) |
| Enumeration Date | 2007-08-17 |
| Last Update Date | 2022-07-21 |