| NPI | 1497040414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 9589) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AK 438) |
| Enumeration Date | 2011-06-17 |
| Last Update Date | 2018-06-12 |