| NPI | 1194496497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 12492) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 25740) |
| Enumeration Date | 2021-09-26 |
| Last Update Date | 2021-11-04 |