| NPI | 1336689363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 13257) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 15631-24) |
| Enumeration Date | 2017-02-23 |
| Last Update Date | 2023-11-06 |