| NPI | 1639233109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 1139) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 6391) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2013-06-03 |