| NPI | 1932557956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 1337924) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 10630) |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2018-07-30 |