| NPI | 1306150602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 8520) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SD 1526) |
| Enumeration Date | 2010-07-29 |
| Last Update Date | 2010-07-29 |