| NPI | 1184350498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 12925560-2401) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: MN 1011890) |
| 146N00000X Emergency Medical Technician, Basic (Licence: UT 2019032972) | |
| 225100000X Physical Therapist (Licence: MN 12715) | |
| Enumeration Date | 2022-07-28 |
| Last Update Date | 2022-07-28 |