| NPI | 1982782546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SD 0066) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 5579) |
| 225100000X Physical Therapist (Licence: IA 00234) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2007-07-08 |