| NPI | 1427395540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: MN 8912) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: SD 0728) |
| Enumeration Date | 2013-01-09 |
| Last Update Date | 2013-01-09 |