| NPI | 1548563521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 8279) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 8282) |
| Enumeration Date | 2010-12-13 |
| Last Update Date | 2010-12-13 |