| NPI | 1033419239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 11064) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 4589) |
| Enumeration Date | 2010-10-22 |
| Last Update Date | 2018-05-14 |