| NPI | 1386296028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 11578) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 14758) |
| Enumeration Date | 2019-07-12 |
| Last Update Date | 2023-05-24 |