| NPI | 1134582653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 9331) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 21787) |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2016-04-01 |