| NPI | 1376511006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 0773) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 5136) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2014-04-24 |