| NPI | 1033881990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 2727) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 12345) |
| Enumeration Date | 2021-09-29 |
| Last Update Date | 2024-08-09 |