| NPI | 1285360131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 12885) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 16059) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2022-07-25 |
| Last Update Date | 2022-10-12 |