| NPI | 1831142892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 6187) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 5899) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: WI 6187-24) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2023-08-25 |