| NPI | 1174550446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 4675) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SD 0383) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2022-04-28 |