| NPI | 1083681407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 1811-024) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 1739) |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2017-08-01 |