| NPI | 1639467988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 8716) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI 3441) |
| 225100000X Physical Therapist (Licence: CO 11238) | |
| 225100000X Physical Therapist (Licence: CA 38362) | |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2017-11-02 |