| NPI | 1659578417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 7925) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 10875-024) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2008-09-05 |