| NPI | 1083215008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 12152) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0017071) |
| Enumeration Date | 2020-11-05 |
| Last Update Date | 2021-10-28 |