| NPI | 1891215364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 10903) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 13772-24) |
| Enumeration Date | 2017-06-26 |
| Last Update Date | 2018-09-20 |