| NPI | 1457554941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 1202) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 7210) |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2007-07-08 |