| NPI | 1235125725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SD 0249) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 2629) |
| 225100000X Physical Therapist (Licence: IA 01622) | |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2007-07-08 |