| NPI | 1184517104 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 13952) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 5231) |
| Enumeration Date | 2025-05-29 |
| Last Update Date | 2025-06-05 |