| NPI | 1639155450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 9974) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 7832) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2016-07-19 |