| NPI | 1669829164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 10472) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305210154) |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2016-08-08 |