| NPI | 1245740083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND PT-2220) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN PT-10789) |
| Enumeration Date | 2017-10-06 |
| Last Update Date | 2018-03-17 |