| NPI | 1487933958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 11981-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 8826) |
| Enumeration Date | 2011-08-15 |
| Last Update Date | 2018-07-30 |