| NPI | 1134777113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 11636) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-32275) |
| Enumeration Date | 2019-09-03 |
| Last Update Date | 2022-06-09 |