| NPI | 1912031022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 1327) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 7874) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2019-07-03 |