| NPI | 1275968695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 9251) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 4222) |
| Enumeration Date | 2013-09-04 |
| Last Update Date | 2013-09-04 |