| NPI | 1255887493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 12520) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT291850) |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2022-01-20 |