| NPI | 1184992604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 5269) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 03401) |
| Enumeration Date | 2011-12-12 |
| Last Update Date | 2024-06-17 |