| NPI | 1114291077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 7387) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 10960-24) |
| Enumeration Date | 2012-02-23 |
| Last Update Date | 2012-02-23 |