| NPI | 1447687199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 13515) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 9383) |
| Enumeration Date | 2013-09-26 |
| Last Update Date | 2016-08-10 |