| NPI | 1801290150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 0766) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 4258) |
| Enumeration Date | 2014-10-15 |
| Last Update Date | 2014-10-15 |