| NPI | 1578974952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 9633) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 12658) |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2019-04-17 |