NPI | 1043720451 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 10966) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 13973-24) |
Enumeration Date | 2017-10-11 |
Last Update Date | 2019-07-29 |