| NPI | 1063823656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 12643) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 9833) |
| Enumeration Date | 2014-05-16 |
| Last Update Date | 2022-06-22 |