| NPI | 1447259445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 2409) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 4964) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2019-09-30 |