| NPI | 1104245802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 1475) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 7800) |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2014-04-09 |