| NPI | 1194968842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 7495) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 10801-024) |
| Enumeration Date | 2009-04-10 |
| Last Update Date | 2017-12-14 |