| NPI | 1710221858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 1320) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 1272-24) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2012-11-15 |