| NPI | 1194310797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 12165) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT016727) |
| Enumeration Date | 2021-03-04 |
| Last Update Date | 2021-04-23 |