| NPI | 1346959079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 12661) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT61336961) |
| Enumeration Date | 2022-11-21 |
| Last Update Date | 2022-11-21 |