| NPI | 1144517053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 13341) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH6457) |
| 225100000X Physical Therapist (Licence: MN 10587) | |
| Enumeration Date | 2011-06-30 |
| Last Update Date | 2017-05-11 |