| NPI | 1043720451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 10966) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 13973-24) |
| Enumeration Date | 2017-10-11 |
| Last Update Date | 2019-07-29 |