| NPI | 1326663030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 12193) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY TP2020001) |
| Enumeration Date | 2020-06-09 |
| Last Update Date | 2021-07-13 |