| NPI | 1235125451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SD 0215) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 6177) |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2007-07-08 |