| NPI | 1063023828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 2498) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 12002) |
| Enumeration Date | 2020-08-13 |
| Last Update Date | 2021-08-19 |