| NPI | 1043240211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 7202) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SD 0736) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2010-03-25 |