| NPI | 1730683327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 14112) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 10520) |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2018-03-20 |