| NPI | 1720168701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 7910) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 20050255496) |
| 225100000X Physical Therapist (Licence: NY 031102-1) | |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2010-09-28 |