| NPI | 1265550966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 7833) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 10387-024) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2019-03-06 |