| NPI | 1023297454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 8011) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 61358) |
| Enumeration Date | 2007-11-02 |
| Last Update Date | 2018-10-22 |