| NPI | 1679634661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 2004) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 7628) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2021-09-10 |