| NPI | 1619538972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 14765-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 11564) |
| Enumeration Date | 2019-06-26 |
| Last Update Date | 2019-06-26 |