| NPI | 1427299288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 7658) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501013584) |
| Enumeration Date | 2009-03-09 |
| Last Update Date | 2009-03-09 |