| NPI | 1104610526 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 13930) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 5227) |
| Enumeration Date | 2025-04-09 |
| Last Update Date | 2025-06-09 |