| NPI | 1447505938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 12540) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 9061) |
| Enumeration Date | 2012-07-20 |
| Last Update Date | 2024-05-24 |