| NPI | 1023459799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 9461) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 3046) |
| Enumeration Date | 2013-07-10 |
| Last Update Date | 2020-09-29 |