| NPI | 1922434695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 10487) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60416104) |
| Enumeration Date | 2013-09-25 |
| Last Update Date | 2016-08-08 |