| NPI | 1225655566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 12552) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01928500) |
| Enumeration Date | 2020-07-02 |
| Last Update Date | 2022-04-06 |