| NPI | 1285153502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 12475) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT013098) |
| Enumeration Date | 2017-09-19 |
| Last Update Date | 2022-01-13 |