| NPI | 1417166687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 881) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 4823) |
| 225100000X Physical Therapist (Licence: ND 0881) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2008-04-02 |