| NPI | 1073603775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 2899) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 014144) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2019-09-24 |