| NPI | 1851558506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SD 1524) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 8556) |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2016-10-25 |