| NPI | 1285742304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MN 8065) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: IL 070010135) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2009-09-30 |