| NPI | 1407235138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 11786) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 13009) |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2020-03-06 |