| NPI | 1679878383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 5486) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 2125) |
| Enumeration Date | 2011-01-12 |
| Last Update Date | 2011-01-12 |