| NPI | 1033590393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 10342) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 13030-024) |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2020-08-11 |