| NPI | 1336313436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 10985-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 8681) |
| Enumeration Date | 2008-04-18 |
| Last Update Date | 2022-03-31 |