| NPI | 1376158097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 11797) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 4485) |
| Enumeration Date | 2020-09-10 |
| Last Update Date | 2022-08-29 |