| NPI | 1174528582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 10385) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 7502) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2017-07-27 |