| NPI | 1811206634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 5787) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 004943) |
| 225100000X Physical Therapist (Licence: OK 3956) | |
| Enumeration Date | 2010-09-28 |
| Last Update Date | 2010-09-28 |