| NPI | 1841507324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 11914-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 8633) |
| Enumeration Date | 2010-09-07 |
| Last Update Date | 2020-04-27 |