| NPI | 1215421961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 11238) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 4645) |
| Enumeration Date | 2018-06-17 |
| Last Update Date | 2021-03-12 |