| NPI | 1891813390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 4520) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05008173A) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2014-07-02 |