| NPI | 1083097125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 9953) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 12118-24) |
| 225100000X Physical Therapist (Licence: IL 070.019559) | |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2015-07-09 |