| NPI | 1487930368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM 4013) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 8850) |
| Enumeration Date | 2011-10-24 |
| Last Update Date | 2011-10-27 |