| NPI | 1366418279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 6384) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 10916-024) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2020-04-02 |