| NPI | 1295850378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT000704) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 1772) |
| 225100000X Physical Therapist (Licence: WI 11003) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2023-08-01 |