| NPI | 1275762312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 1554) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 8323) |
| Enumeration Date | 2009-07-10 |
| Last Update Date | 2020-05-09 |