| NPI | 1750784005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 1647) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 9105) |
| Enumeration Date | 2014-10-01 |
| Last Update Date | 2014-10-01 |