| NPI | 1982883401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 2054) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ND 0411) |
| Enumeration Date | 2007-10-31 |
| Last Update Date | 2007-10-31 |