| NPI | 1124376892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 12179-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 9109) |
| Enumeration Date | 2012-08-28 |
| Last Update Date | 2016-03-01 |