| NPI | 1417186636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: WI 11386-24) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MN 8314) |
| Enumeration Date | 2009-07-09 |
| Last Update Date | 2017-05-12 |