| NPI | 1427468735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 10994) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 11805) |
| Enumeration Date | 2014-05-08 |
| Last Update Date | 2018-03-21 |