| NPI | 1740576768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 3120) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL-11220) |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2014-03-18 |