| NPI | 1225008634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 8071) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MT 1880PT) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2019-10-11 |