| NPI | 1083163588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 10491) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 11052) |
| Enumeration Date | 2016-09-25 |
| Last Update Date | 2016-09-25 |