| NPI | 1295247179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 10639) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 13410) |
| 225100000X Physical Therapist (Licence: IN 05012500A.) | |
| 225100000X Physical Therapist (Licence: MD 27399) | |
| Enumeration Date | 2017-10-31 |
| Last Update Date | 2021-01-13 |