NPI | 1073870812 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 9245) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 11921-024) |
Enumeration Date | 2012-04-18 |
Last Update Date | 2022-07-21 |