| NPI | 1760718084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 8368) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 004294) |
| 225100000X Physical Therapist (Licence: IL 070014085) | |
| Enumeration Date | 2009-10-21 |
| Last Update Date | 2009-10-21 |