| NPI | 1184156853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 10417) |
| Additional Taxonomies | 2251C2600X Physical Therapist, Cardiopulmonary (Licence: MN 10417) |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2019-04-24 |