| NPI | 1093005118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 6412) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 8856) |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2015-01-15 |