| NPI | 1316973266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 6286) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 6276-024) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2013-03-28 |