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 |