| NPI | 1659704823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: SD 1777) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: MN 9358) |
| Enumeration Date | 2013-08-12 |
| Last Update Date | 2018-04-09 |