| NPI | 1003093683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SD 0165) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 2909) |
| 225100000X Physical Therapist (Licence: IA 3511) | |
| Enumeration Date | 2008-01-26 |
| Last Update Date | 2008-01-26 |