| NPI | 1114467131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 113044) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 62149) |
| 225100000X Physical Therapist (Licence: MN 11771) | |
| Enumeration Date | 2017-02-24 |
| Last Update Date | 2022-08-17 |